Antidiabetics

Ability to drive, oral antidiabetics

Take precautions to avoid hypoglycaemia whilst driving or operating machinery

ACE inhibitors, antidiabetics ---> SmPC of [enalapril] of eMC

Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.

Acebutolol, oral antidiabetics ---> SmPC of [brinzolamide/timolol] of EMA

The beta-blocker may increase the hypoglycaemic effect of antidiabetic agent. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia

Aceclofenac [1], oral antidiabetics ---> SmPC of [1] of eMC

Clinical studies have shown that diclofenac can be given together with oral antidiabetic agents with influencing their clinical effect. However, there have been isolated reports of hypoglycaemic and hyperglycaemic effects

Acemetacine, oral antidiabetics

Monitorization of the blood-sugar concentration

Acenocoumarol, oral antidiabetics

The co-administration may enhance the anticoagulant effect of acenocoumarol and increase the bleeding risk

Acetazolamide, antidiabetics

Possible potentiation of the hypoglycemic effects

Acetylsalicylic acid, oral antidiabetics

Decreased blood sugar level

Adrenaline [1], oral antidiabetics ---> SmPC of [1] of eMC

Adrenaline-induced hyperglycaemia may lead to loss of blood-sugar control in diabetic patients treated with hypoglycaemic agents.

Aliskiren/amlodipine/hydrochlorothiazide [1], oral antidiabetics ---> SmPC of [1] of EMA

Thiazides may alter glucose tolerance. Dose adjustment of the antidiabetic medicinal product may be necessary

Aliskiren/hydrochlorothiazide [1], oral antidiabetics ---> SmPC of [1] of EMA

Thiazides may alter glucose tolerance. Dose adjustment of the antidiabetic medicinal product may be necessary

Amfepramone, oral antidiabetics

The need for blood glucose lowering drugs (e. g. insulina) can be influenced

Amiloride, oral antidiabetics

Decreased antidiabetic effect

Amiloride/hydrochlorothiazide, oral antidiabetics

The effect of oral antidiabetics or insulin can be weaken with the concomitant administration of amiloride/hydrochlorothiazide

Amlodipine/valsartan/hydrochlorothiazide [1], oral antidiabetics ---> SmPC of [1] of EMA

Thiazides may alter glucose tolerance. Dose adjustment of the antidiabetic medicinal product may be necessary.

Anabolic steroids, antidiabetics

The anabolic steroid may improve glucose tolerance and decrease the need for antidiabetic drug

Anabolic steroids, oral antidiabetics

Anabolic steroids may improve glucose tolerance and decrease the need for insulin or other anti-diabetic drugs in diabetics.

Androgens, oral antidiabetics

Androgens may improve glucose tolerance and decrease the need for anti-diabetic medicines in diabetic subjects

Antibiotics, oral antidiabetics

The co-administration may enhance the antidiabetic effect

Antidiabetics, bambuterol

The co-administration may decrease the hypoglycemic effect of antidiabetic agent

Antidiabetics, bamethane

Possible weakening of pharmacological effect of antidiabetic drug (decreased hypoglycemic effect)

Antidiabetics, bendroflumethiazide

Dosage adjustment of the antidiabetic medicinal product may be required

Antidiabetics, beta-adrenergic agonists

The administration of beta-agonists is associated with a rise of blood glucose, which can be interpreted as an attenuation of anti-diabetic therapy; therefore individual anti-diabetic therapy may need to be adjusted

Antidiabetics, betablockers ---> SmPC of [latanoprost/timolol] of eMC

Beta-blockers may increase the hypoglycaemic effect of antidiabetic agents. Beta-blockers can mask the signs and symptoms of hypoglycaemia

Antidiabetics, bezafibrate

The action of anti-diabetic medication might be potentiated

Antidiabetics, carteolol ---> SmPC of [brinzolamide/timolol] of EMA

The beta-blocker may increase the hypoglycaemic effect of insulin. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia

Antidiabetics, chlormadinone

Change of tolerance to glucose and possible decrease of antidiabetic effect

Antidiabetics, chlorpromazine [2] ---> SmPC of [2] of eMC

Possible increase of glycemia (decreased insulin release). The concomitant use should be done with caution

Antidiabetics, clenbuterol

The co-administration may decrease the antidiabetic effect

Antidiabetics, cloprednol

Decreased antidiabetic effect

Antidiabetics, deflazacort

The desired effects of hypoglycaemic agents (including insulin) are antagonized by corticosteroids

Antidiabetics, diclofenac [2] ---> SmPC of [2] of eMC

There have been isolated reports of hypoglycaemic and hyperglycaemic effects which have required adjustment to the dosage of hypoglycaemic agents.

Antidiabetics, dorzolamide/timolol [2] ---> SmPC of [2] of eMC

Beta-blockers may increase the hypoglycaemic effect of antidiabetic agents and mask the signs and symptoms of acute hypoglycaemia

Antidiabetics, etanercept [2] ---> SmPC of [2] of EMA

There have been reports of hypoglycaemia following initiation of etanercept in patients receiving medication for diabetes, necessitating a reduction in anti-diabetic medication in some of these patients.

Antidiabetics, etilefrine

The co-administration may decrease the hypoglycemic effect

Antidiabetics, fenoterol

Decreased hypoglycaemic effect

Antidiabetics, fibrates

Increasing of the blood-glucose-lowering effect

Antidiabetics, fluocortolone

Decreased antidiabetic effect

Antidiabetics, fluphenazine [2] ---> SmPC of [2] of eMC

Phenothiazines may impair the control of diabetes.

Antidiabetics, fluvoxamine [2] ---> SmPC of [2] of eMC

Glycaemic control may be disturbed (i.e., hyperglycemia, hypoglycemia, decreased glucose tolerance), especially in the early stages of treatment. The dosage of anti-diabetic drugs may need to be adjusted.

Antidiabetics, formoterol [2] ---> SmPC of [2] of eMC

Due to the hyperglycaemic effect of beta2-stimulants, including formoterol, additional blood glucose controls are recommended in diabetic patients.

Antidiabetics, furosemide [2] ---> SmPC of [2] of eMC

Furosemide may attenuate the effects of the anti-diabetic drug

Antidiabetics, ginseng

Ginseng may impair the blood glucose levels.

Antidiabetics, glucocorticoids ---> SmPC of [methylprednisolone] of eMC

The desired effects of hypoglycaemic agents (including insulin) are antagonized by corticosteroids

Antidiabetics, hydrocortisone

Decreased hypoglycaemic effect

Antidiabetics, isocarboxazid

Concurrent administration of isocarboxazid with hypoglycaemic agents may lead to potentiation of their effects.

Antidiabetics, latanoprost/timolol [2] ---> SmPC of [2] of eMC

Beta-blockers may increase the hypoglycaemic effect of antidiabetic agents. Beta-blockers can mask the signs and symptoms of hypoglycaemia

Antidiabetics, LH-RH agonists ---> SmPC of [buserelin] of eMC

In some patients treated with GnRH-agonists, change in glucose tolerance is observed. In diabetic patients blood glucose levels must be checked regularly (risk of deterioration of metabolic control).

Antidiabetics, loop diuretics

Decreased hypoglycaemic effect

Antidiabetics, magnesium hydroxide [2] ---> SmPC of [2] of eMC

The co-administration of magnesium hydroxide may increase the absorption of antidiabetic agents. Separate administration by 2-3 hours

Antidiabetics, methylprednisolone

The desired effects of hypoglycaemic agents (including insulin) are antagonized by corticosteroids

Antidiabetics, nicotinates

Decreased blood-glucose lowering effect

Antidiabetics, nicotinic acid

Decreased blood-glucose lowering effect

Antidiabetics, noradrenaline

Noradrenaline reduces the hypoglycemic effect of antidiabetic agent

Antidiabetics, norepinephrine

Noradrenaline reduces the hypoglycemic effect of antidiabetic agent

Antidiabetics, oral contraceptives

Effect on glucose tolerance

Antidiabetics, orciprenaline

Orciprenaline can decrease the hypoglycemic effect of antidiabetic agents

Antidiabetics, orlistat [2] ---> SmPC of [2] of EMA

In clinical trials, the decrease in bodyweight with orlistat treatment was less in type II diabetic patients than in non-diabetic patients. Antidiabetic medicinal product treatment may have to be closely monitored when taking orlistat.

Antidiabetics, oxaprozin

The co-administration may enhance the hypoglycemic effect

Antidiabetics, pasireotide [2] ---> SmPC of [2] of EMA

Dose adjustments (decrease or increase) of insulin and antidiabetic medicinal products may be required when administered concomitantly with pasireotide

Antidiabetics, phenothiazines ---> SmPC of [fluphenazine] of eMC

Phenothiazines may impair the control of diabetes.

Antidiabetics, piretanide

Decreased hypoglycaemic effect

Antidiabetics, prednisone [2] ---> SmPC of [2] of eMC

The blood sugar lowering effect is reduced.

Antidiabetics, repaglinide [2] ---> SmPC of [2] of EMA

Other antidiabetics may enhance and/or prolong the hypoglycaemic effect of repaglinide

Antidiabetics, reproterol

The blood-sugar reducing effect of antidiabetic drugs may decrease with reproterol

Antidiabetics, salbutamol [2] ---> SmPC of [2] of eMC

The administration of beta-agonists is associated with a rise of blood glucose, which can be interpreted as an attenuation of anti-diabetic therapy; therefore individual anti-diabetic therapy may need to be adjusted

Antidiabetics, salicylates

Increased hypoglycemic effect.

Antidiabetics, tadalafil [2] ---> SmPC of [2] of EMA

Specific interaction studies with antidiabetic medicinal products were not conducted.

Antidiabetics, terbutaline [2] ---> SmPC of [2] of eMC

Due to the hyperglycaemic effects of beta2-agonists, additional blood glucose controls are recommended initially in diabetic patients.

Antidiabetics, thioridazine

The phenothiazine affects carbohydrate metabolism and may therefore interfere with control of diabetic patients

Antidiabetics, thyroid hormones

Increased or decreased hypoglycemia

Antidiabetics, tiopronin

Increased effect of antidiabetic agent

Antidiabetics, torasemid [2] ---> SmPC of [2] of eMC

The action of anti-diabetic drugs may be reduced by torasemide

Antidiabetics, verapamil

Increased plasma levels of antidiabetic agent

Antidiabetics, verteporfin [2] ---> SmPC of [2] of EMA

It is possible that concomitant use of other photosensitizing medicinal products could increase the potential for photosensitivity reactions. Caution should be exercised

Antidiabetics, xantinol nicotinate

Decreased blood-glucose lowering effect

Antidiabetics, xipamide [2] ---> SmPC of [2] of eMC

Diabetic patients may require an increase in their dose of insulin or oral hypoglycaemic drug.

Antidiabetics, zuclopenthixol [2] ---> SmPC of [2] of eMC

As described for other psychotropics zuclopenthixol may modify insulin and glucose responses calling for adjustment of the antidiabetic therapy in diabetic patients.

Articaine/epinephrine, oral antidiabetics

Epinephrine may inhibit the insulin release in pancreas and so decrease the effect of oral antidiabetics

Atenolol, oral antidiabetics

Concomitant use of atenolol with insulin and oral antidiabetic drugs may intensify the blood sugar lowering effect. Beta-adrenergic blockade may prevent the appearance of signs of hypoglycaemia (tachycardia).

Atenolol/chlortalidone, oral antidiabetics [2] ---> SmPC of [2] of eMC

Concomitant use with insulin and oral antidiabetic drugs may lead to the intensification of the blood sugar lowering effects of these drugs.

Atenolol/nifedipine, oral antidiabetics [2] ---> SmPC of [2] of eMC

Concomitant use with insulin and oral antidiabetic drugs may lead to the intensification of the blood sugar-lowering effects of these drugs.

Benazepril, oral antidiabetics

Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.

Bendroflumethiazide, oral antidiabetics

The hypoglycaemic effect may be reduced

Betablockers, oral antidiabetics ---> SmPC of [brinzolamide/timolol] of EMA

The beta-blocker may increase the hypoglycaemic effect of antidiabetic agent. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia

Betaxolol, oral antidiabetics ---> SmPC of [brinzolamide/timolol] of EMA

The beta-blocker may increase the hypoglycaemic effect of antidiabetic agent. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia

Bisacodyl, oral antidiabetics

The co-administration may decrease the absorption of the oral antidiabetic agent

Bisoprolol [1], oral antidiabetics ---> SmPC of [1] of eMC

Increase of blood sugar lowering effect. Blockade of beta-adrenoceptors may mask symptoms of hypoglycaemia.

Bortezomib [1], oral antidiabetics ---> SmPC of [1] of EMA

During clinical trials, hypoglycemia and hyperglycemia were uncommonly and commonly reported in diabetic patients receiving oral hypoglycemics.

Brinzolamide/timolol [1], oral antidiabetics ---> SmPC of [1] of EMA

The beta-blocker may increase the hypoglycaemic effect of antidiabetic agent. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia

Buserelin [1], oral antidiabetics ---> SmPC of [1] of eMC

In some patients treated with GnRH-agonists, change in glucose tolerance is observed. In diabetic patients blood glucose levels must be checked regularly (risk of deterioration of metabolic control).

Captopril [1], oral antidiabetics ---> SmPC of [1] of eMC

Pharmacological studies have shown that ACE inhibitors can potentiate the blood glucose-reducing effects of insulin and oral antidiabetics in diabetics.

Carteolol, oral antidiabetics

All betablocker may mask certain symptoms of hypoglycaemia (palpitations, tachycardia).

Carvedilol [1], oral antidiabetics ---> SmPC of [1] of eMC

The blood sugar-lowering effect of oral diabetic medicines may be intensified. Symptoms of hypoglycaemia may be masked.

Celiprolol [1], oral antidiabetics ---> SmPC of [1] of eMC

Beta blockers may intensify the blood sugar lowering effects of oral antidiabetic drugs. In addition, beta-adrenoceptor blockers may mask the symptoms of thyrotoxicosis or hypoglycaemia (in particular, tachycardia).

Chlortalidone, oral antidiabetics

It may prove necessary to adjust the dosage of insulin and oral anti-diabetic agents.

Cilazapril [1], oral antidiabetics ---> SmPC of [1] of eMC

Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.

Clarithromycin [1], oral antidiabetics ---> SmPC of [1] of eMC

There have been rare reports of hypoglycaemia, some of which have occurred in patients on concomitant oral hypoglycaemic agents or insulin

Clopamide, oral antidiabetics

Decreased hypoglucemic effect

Clopidogrel/acetylsalicylic acid [1], oral antidiabetics ---> SmPC of [1] of EMA

Interactions with oral hypoglycemic agents and higher (anti-inflammatory) doses of ASA have been reported

Corticosteroids, oral antidiabetics ---> SmPC of [triamcinolone acetonide] of eMC

Corticosteroids may increase blood glucose; diabetic control should be monitored, especially when corticosteroids are initiated, discontinued, or changed in dosage.

Cyclophosphamide, oral antidiabetics

Oral hypoglycaemic agents may be potentiated by cyclophosphamide.

Cyproterone [1], oral antidiabetics ---> SmPC of [1] of eMC

The requirement for oral antidiabetics can change

Cyproterone/ethinylestradiol, oral antidiabetics

Oral contraceptives may decrease glucose tolerance resulting in hyperglycemia and decreased efficacy of oral antidiabetics and insulin

Danazol, oral antidiabetics

Danazol has diabetogenic effect and may cause an increase in blood glucose levels.

Delapril [1], oral antidiabetics ---> SmPC of [1] of eMC

Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.

Disulfiram, oral antidiabetics

Disulfiram inhibits the metabolism of many drugs which are converted in the liver and thereby enhances efficacy.

Enalapril [1], oral antidiabetics ---> SmPC of [1] of eMC

Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.

Enalapril/hydrochlorothiazide [1], oral antidiabetics ---> SmPC of [1] of eMC

Epidemiological studies have suggested that concomitant administration of ACE inhibitors and antidiabetic medicines (insulins, oral hypoglycaemic agents) may cause an increased blood-glucose-lowering effect with risk of hypoglycaemia.

Epinephrine [1], oral antidiabetics ---> SmPC of [1] of eMC

Adrenaline-induced hyperglycaemia may lead to loss of blood-sugar control in diabetic patients treated with hypoglycaemic agents.

Escitalopram [1], oral antidiabetics ---> SmPC of [1] of eMC

In patients with diabetes, treatment with an SSRI may alter glycaemic control (hypoglycaemia or hyperglycaemia). Insulin and/or oral hypoglycaemic dosage may need to be adjusted.

Esmolol [1], oral antidiabetics ---> SmPC of [1] of eMC

Concomitant use of esmolol and oral antidiabetic drugs may intensify the blood sugar lowering effect (especially non-selective beta-blockers). Beta-adrenergic blockade may prevent the appearance of signs of hypoglycemia (tachycardia).

Estradiol valerate/norgestrel [1], oral antidiabetics ---> SmPC of [1] of eMC

The requirement for oral antidiabetics or insulin can change.

Estrogens, oral antidiabetics

The hypoglycaemic effect may be reduced

Ethinyl estradiol, oral antidiabetics

The doses of insulin or hypoglycaemic drugs may need to be adjusted due to the mild diabetogenic effect of ethinylestradiol.

Ethinylestradiol/chlormadinone, oral antidiabetics

The requirement for oral antidiabetics or insulin can change as a result of the effect on glucose tolerance.

Ethinylestradiol/gestodene, oral antidiabetics

Oral contraceptives may decrease glucose tolerance resulting in hyperglycemia and decreased efficacy of oral antidiabetics and insulin

Felodipine/metoprolol, oral antidiabetics

The beta-blocker may increase the hypoglycaemic effect of antidiabetic agents

Felodipine/ramipril [1], oral antidiabetics ---> SmPC of [1] of eMC

Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.

Fibrates, oral antidiabetics

Potentiation of the blood-glucose-lowering effect and, thus, in some instances hypoglycaemia

Fluconazole, oral antidiabetics

Clinically significant hypoglycemia may be precipitated by the use of fluconazole with oral hypoglycemic agents.

Fludrocortisone, oral antidiabetics

Corticosteroids may increase blood glucose

Fluoxetine [1], oral antidiabetics ---> SmPC of [1] of eMC

In patients with diabetes, treatment with an SSRI may alter glycaemic control. Hypoglycaemia has occurred during therapy with fluoxetine and hyperglycaemia has developed following discontinuation.

Flurbiprofen [1], oral antidiabetics ---> SmPC of [1] of eMC

Hypoglycaemic and hyperglycaemic effects.

Fosinopril [1], oral antidiabetics ---> SmPC of [1] of eMC

Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.

Fosphenytoin [1], oral antidiabetics ---> SmPC of [1] of eMC

Phenytoin may increase serum glucose levels and therefore adjustment for insulin or oral antidiabetic agents may be necessary.

Gemfibrozil [1], oral antidiabetics ---> SmPC of [1] of eMC

There have been reports of hypoglycaemic reactions after concomitant use with gemfibrozil and hypoglycaemic agents (oral agents and insulin).Monitoring of glucose levels is recommended.

Gestagens, oral antidiabetics

Change of tolerance to glucose and possible decrease of antidiabetic effect

Glibenclamide, oral antidiabetics

The co-administration may enhance the hypoglycemic effect

Gliclazide [1], oral antidiabetics ---> SmPC of [1] of eMC

Potentiation of the blood glucose lowering effect and thus, in some instances, hypoglycaemia may occur when other antidiabetic agents are taken

Glimepiride [1], oral antidiabetics ---> SmPC of [1] of eMC

Potentiation of the blood-sugar-lowering effect and possible hypoglycaemia

Gliquidone, oral antidiabetics

Hypoglycemic reactions may occur as expression of enhancement effect of gliquidone with gliquidone is co-administered with oral antidiabetics and insulin.

Heparin, oral antidiabetics ---> SmPC of [sodium heparin] of eMC

Heparin may increase the effect of oral antidiabetic agents

Human insulin [1], oral antidiabetics ---> SmPC of [1] of EMA

Possible reduction of the patient's insulin requirement

Hydrochlorothiazide, oral antidiabetics ---> SmPC of [aliskiren/hydrochlorothiazide] of EMA

Thiazides may alter glucose tolerance. Dose adjustment of the antidiabetic medicinal product may be necessary

Hydroxychloroquine [1], oral antidiabetics ---> SmPC of [1] of eMC

As hydroxychloroquine may enhance the effects of a hypoglycaemic treatment, a decrease in doses of insulin or antidiabetic drugs may be required.

Hydroxyprogesterone, oral antidiabetics

Change of tolerance to glucose and possible decrease of antidiabetic effect

Hyperglycemic agents, oral antidiabetics

The hypoglycaemic effect may be reduced

Ifosfamide, oral antidiabetics

The co-administration may increase the blood-sugar reducing effect

IMAOs, oral antidiabetics

The co-administration may improve the glucose tolerance and enhance the hypoglycemic effect

Imidapril [1], oral antidiabetics ---> SmPC of [1] of eMC

The use of ACE inhibitors may increase the hypoglycaemic effect in diabetic patients treated with insulin or hypoglycaemia sulphonamides.

Imipenem/cilastatin [1], oral antidiabetics ---> SmPC of [1] of eMC

There have been many reports of increases in the anti-coagulant effects of orally administered anti-coagulant agents, including warfarin in patients who are concomitantly receiving antibacterial agents.

Insulin aspart [1], oral antidiabetics ---> SmPC of [1] of EMA

Possible reduction of the insulin requirements

Insulin degludec [1], oral antidiabetics ---> SmPC of [1] of EMA

Possible reduction of the insulin requirements

Insulin degludec/insulin aspart [1], oral antidiabetics ---> SmPC of [1] of EMA

Possible reduction of the insulin requirements

Insulin degludec/liraglutide [1], oral antidiabetics ---> SmPC of [1] of EMA

Possible reduction of the Xultophy requirements

Insulin detemir [1], oral antidiabetics ---> SmPC of [1] of EMA

Possible reduction of the insulin requirements

Insulin glargin [1], oral antidiabetics ---> SmPC of [1] of EMA

Enhanced blood-glucose-lowering effect and increased susceptibility to hypoglycaemia

Insulin glulisin [1], oral antidiabetics ---> SmPC of [1] of EMA

Possible enhancement of blood-glucose-lowering activity and increased susceptibility to hypoglycaemia

Insulin lispro [1], oral antidiabetics ---> SmPC of [1] of EMA

Insulin requirements may be reduced in the presence of medicinal products with hypoglycaemic activity

Insulin, oral antidiabetics

Possible reduction of the insulin requirements

Ivabradine [1], oral antidiabetics ---> SmPC of [1] of EMA

In pivotal phase III clinical trials oral antidiabetics were routinely combined with ivabradine with no evidence of safety concerns

Kebuzone, oral antidiabetics

The co-administration may enhance the effects and increase the risk of hypoglycemia

Ketotifen, oral antidiabetics

The co-administration may decrease the platelet count

Labetalol, oral antidiabetics ---> SmPC of [brinzolamide/timolol] of EMA

The beta-blocker may increase the hypoglycaemic effect of antidiabetic agent. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia

Levobunolol, oral antidiabetics ---> SmPC of [brinzolamide/timolol] of EMA

The beta-blocker may increase the hypoglycaemic effect of insulin. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia

Levofloxacin [1], oral antidiabetics ---> SmPC of [1] of EMA

As with all quinolones, disturbances in blood glucose, including both hypoglycaemia and hyperglycaemia have been reported, usually in diabetic patients receiving concomitant treatment with an oral hypoglycaemic agent (e.g. glibenclamide) or with insulin.

Levothyroxine [1], oral antidiabetics ---> SmPC of [1] of eMC

Blood sugar levels are raised and dosage of anti-diabetic agents may require adjustment.

Lisinopril [1], oral antidiabetics ---> SmPC of [1] of eMC

Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.

Losartan/hydrochlorothiazide [1], oral antidiabetics ---> SmPC of [1] of eMC

The treatment with a thiazide may influence the glucose tolerance. Dosage adjustment of the antidiabetic drug may be required.

Manidipine, oral antidiabetics

No interactions were observed with oral hypoglycemic drugs

Maprotiline, oral antidiabetics

The co-administration may enhance the blood-sugar reducing effect

Medroxyprogesterone, oral antidiabetics

Decreased glucose tolerance and may be necessary to adjust the dosage of hypoglycaemic agent

Mefruside, oral antidiabetics

The hypoglycaemic effect may be reduced

Megestrol, oral antidiabetics

Change of tolerance to glucose and possible decrease of antidiabetic effect

Metipranolol, oral antidiabetics ---> SmPC of [brinzolamide/timolol] of EMA

The beta-blocker may increase the hypoglycaemic effect of insulin. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia

Metolazone, oral antidiabetics

Metolazone may cause hyperglycemia. It can be necessary to adjust the dose of antidiabetic agent

Metoprolol [1], oral antidiabetics ---> SmPC of [1] of eMC

It may be necessary to adjust the dose of the hypoglycaemic agent in labile or insulin-dependent diabetes. Beta-adrenergic blockade may prevent the appearance of signs of hypoglycaemia (tachycardia)

Metreleptin [1], oral antidiabetics ---> SmPC of [1] of EMA

When starting therapy with Myalepta there is a risk of hypoglycaemia in patients who are on anti-diabetic medicinal products, in particular insulin or insulin secretagogues

Miconazole, oral antidiabetics

Potentiation of the blood-glucose-lowering effect and, thus, in some instances hypoglycaemia. Caution is recommended

Moexipril [1], oral antidiabetics ---> SmPC of [1] of eMC

Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.

Nadolol, oral antidiabetics ---> SmPC of [brinzolamide/timolol] of EMA

The beta-blocker may increase the hypoglycaemic effect of antidiabetic agent. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia

Naltrexone/bupropion [1], oral antidiabetics ---> SmPC of [1] of EMA

As treatment with naltrexone/bupropion may result in lowered glucose in patients with diabetes, the dose of insulin and/or oral diabetic medicines should be assessed to minimise the risk of hypoglycaemia, which could predispose patients to seizure

Nandrolone, oral antidiabetics

Anabolic steroids may improve glucose tolerance and decrease the need for insulin or other anti-diabetic drugs in diabetics.

Nebivolol [1], oral antidiabetics ---> SmPC of [1] of eMC

Although nebivolol does not affect glucose levels, concomitant use may mask symptoms of hypoglycaemia (palpitations, tachycardia).

Norethisterone enantate, oral antidiabetics

The requirement for oral antidiabetics or insulin can change as a result of the effect on glucose tolerance.

Nortriptyline, oral antidiabetics

Nortriptyline may enhance the blood-glucose reducing effect of insulin and oral antidiabetic drugs

NSAID, oral antidiabetics

Hypoglycaemic and hyperglycaemic effects.

Oral antidiabetics, oral contraceptives ---> SmPC of [cyproterone/ethinylestradiol] of eMC

Oral contraceptives may decrease glucose tolerance resulting in hyperglycemia and decreased efficacy of oral antidiabetics and insulin

Oral antidiabetics, orciprenaline

Orciprenaline can decrease the hypoglycemic effect of antidiabetic agents

Oral antidiabetics, oxprenolol ---> SmPC of [brinzolamide/timolol] of EMA

The beta-blocker may increase the hypoglycaemic effect of antidiabetic agent. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia

Oral antidiabetics, paroxetine [2] ---> SmPC of [2] of eMC

In patients with diabetes, treatment with an SSRI may alter glycaemic control. Insulin and/or oral hypoglycaemic dosage may need to be adjusted.

Oral antidiabetics, pegvisomant [2] ---> SmPC of [2] of EMA

Patients receiving insulin or oral hypoglycaemic medicinal products may require dose reduction of these active substances due to the effect of pegvisomant on insulin sensitivity

Oral antidiabetics, pentoxifylline [2] ---> SmPC of [2] of eMC

Pentoxifylline may intensify the hypoglycaemic action

Oral antidiabetics, perindopril [2] ---> SmPC of [2] of eMC

Epidemiological studies have suggested that concomitant administration of ACE inhibitors and antidiabetic medicines (insulins, oral hypoglycaemic agents) may cause an increased blood-glucose lowering effect with risk of hypoglycaemia.

Oral antidiabetics, phenelzine [2] ---> SmPC of [2] of eMC

Phenelzine may potentiate the action of hypoglycaemic agents

Oral antidiabetics, phenothiazines ---> SmPC of [fluphenazine] of eMC

Phenothiazines may impair the control of diabetes.

Oral antidiabetics, phenylbutazone

Phenylbutazone can displace the antidiabetic from its plasma protein binding and increase its effects

Oral antidiabetics, phenytoin ---> SmPC of [fosphenytoin] of eMC

Phenytoin may increase serum glucose levels and therefore adjustment for insulin or oral antidiabetic agents may be necessary.

Oral antidiabetics, pindolol ---> SmPC of [brinzolamide/timolol] of EMA

The beta-blocker may increase the hypoglycaemic effect of antidiabetic agent. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia

Oral antidiabetics, pindolol/clopamide

Concomitant use of beta-blockers may intensify the blood sugar lowering effect of insulin and other antidiabetic drugs. Use of beta-blockers may mask the symptoms of hypoglycaemia (tachycardia, tremor).

Oral antidiabetics, pioglitazone/glimepiride [2] ---> SmPC of [2] of EMA

Potentiation of the blood-glucose-lowering effect and, thus, in some instances hypoglycaemia may occur

Oral antidiabetics, piretanide

The antidiabetic effect may be diminished by the co-administration of piretanide

Oral antidiabetics, prednisolone

Decreased antidiabetic effect

Oral antidiabetics, pregnancy ---> SmPC of [gliclazide] of eMC

Oral hypoglycaemic agents are not suitable, insulin is the drug of first choice for treatment of diabetes during pregnancy.

Oral antidiabetics, procarbazine

The co-administration may enhance the hypoglycemic effect

Oral antidiabetics, progesterone

Change of tolerance to glucose and possible decrease of antidiabetic effect

Oral antidiabetics, propranolol [2] ---> SmPC of [2] of eMC

Propranolol modifies the tachycardia of hypoglycaemia; caution should be exercised in the concomitant use of propranolol and hypoglycaemic therapy in diabetic patients. Propranolol may prolong the hypoglycaemic response to insulin.

Oral antidiabetics, prothionamide

The dose of insulin or oral antidiabetics must be reduced

Oral antidiabetics, pyrazinamide

Pyrazinamide may enhance the hypoglycemic effect of oral antidiabetic agent

Oral antidiabetics, quinapril [2] ---> SmPC of [2] of eMC

Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.

Oral antidiabetics, quinine

Concurrent use of quinine with oral hypoglycaemics may increase the risk of hypoglycaemia.

Oral antidiabetics, quinolones ---> SmPC of [levofloxacin] of EMA

As with all quinolones, disturbances in blood glucose, including both hypoglycaemia and hyperglycaemia have been reported, usually in diabetic patients receiving concomitant treatment with an oral hypoglycaemic agent (e.g. glibenclamide) or with insulin.

Oral antidiabetics, ramipril [2] ---> SmPC of [2] of eMC

Hypoglycaemic reactions may occur. Blood glucose monitoring is recommended.

Oral antidiabetics, rifabutin [2] ---> SmPC of [2] of eMC

Rifabutin has been shown to induce the enzymes of the cytochrome P450 3A subfamily and therefore may affect the pharmacokinetic behaviour of drugs metabolised by the enzymes belonging to this subfamily.

Oral antidiabetics, rifampicin [2] ---> SmPC of [2] of eMC

Rifampicin is a potent inducer of certain cytochrome P-450 enzymes. Coadministration of rifampicin with drugs that are also metabolised through these cytochrome P-450 enzymes may accelerate the metabolism and reduce the activity of these other drugs.

Oral antidiabetics, ritodrine

Antidiabetic drug requirements may be increased by medicinal products with hyperglycaemic activity

Oral antidiabetics, sertraline

Sertraline may alter glycaemic control

Oral antidiabetics, sodium heparin

Heparin may increase the effect of oral antidiabetic agents

Oral antidiabetics, somatropin [2] ---> SmPC of [2] of EMA

Patients taking insulin for diabetes mellitus should be carefully monitored during treatment with somatropin. Because hGH may induce a state of insulin resistance, an adjustment of the insulin dose may be required.

Oral antidiabetics, sotalol [2] ---> SmPC of [2] of eMC

Hyperglycaemia may occur, and the dosage of antidiabetic drugs may require adjustment. Symptoms of hypoglycaemia (tachycardia) may be masked by beta-blocking agents.

Oral antidiabetics, spirapril [2] ---> SmPC of [2] of eMC

Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.

Oral antidiabetics, SSRI ---> SmPC of [escitalopram] of eMC

In patients with diabetes, treatment with an SSRI may alter glycaemic control (hypoglycaemia or hyperglycaemia). Insulin and/or oral hypoglycaemic dosage may need to be adjusted.

Oral antidiabetics, sulfacetamide

Potentiation of the blood-sugar-lowering effect and possible hypoglycaemia

Oral antidiabetics, sulfadiazine

Potentiation of the blood-sugar-lowering effect and possible hypoglycaemia

Oral antidiabetics, sulfonylureas

Potentiation of the blood-glucose-lowering effect and, thus, in some instances hypoglycaemia

Oral antidiabetics, sulindac

Possible increase of antidiabetic effect due to displacement from plasma proteins

Oral antidiabetics, sulphamides

Potentiation of the blood-sugar-lowering effect and possible hypoglycaemia

Oral antidiabetics, sulphonamides

Potentiation of the blood-sugar-lowering effect and possible hypoglycaemia

Oral antidiabetics, sympathomimetics

The hypoglycaemic effect may be reduced

Oral antidiabetics, tacrolimus [2] ---> SmPC of [2] of EMA

Tacrolimus is extensively bound to plasma proteins. Possible interactions with other active substances known to have high affinity for plasma proteins should be considered

Oral antidiabetics, talinolol

Concomitant use of talinolol with insulin or oral antidiabetic drugs may intensify or prolong the blood sugar lowering effect. The signs of hypoglycaemia, specially tachycardia and tremor, may be masked or decreased

Oral antidiabetics, telmisartan/hydrochlorothiazide [2] ---> SmPC of [2] of EMA

Thiazides may alter glucose tolerance. Dose adjustment of the antidiabetic medicinal product may be necessary

Oral antidiabetics, teniposide

The co-administration may potentiate the antidiabetic effect

Oral antidiabetics, testosterone undecanoate

In diabetic patients the metabolic effects of testosterone may decrease blood glucose and therefore insulin requirements.

Oral antidiabetics, testosterone [2] ---> SmPC of [2] of EMA

In diabetic patients the metabolic effects of testosterone may decrease blood glucose and therefore insulin requirements.

Oral antidiabetics, tetracosactide

Decreased antidiabetic effect

Oral antidiabetics, thiazides ---> SmPC of [aliskiren/hydrochlorothiazide] of EMA

Thiazides may alter glucose tolerance. Dose adjustment of the antidiabetic medicinal product may be necessary

Oral antidiabetics, thioctic acid

Possible enhancement of the hypoglycaemic effect

Oral antidiabetics, thyroid hormones

The co-administration may decrease the effect of antidiabetic agent

Oral antidiabetics, timolol ---> SmPC of [brinzolamide/timolol] of EMA

The beta-blocker may increase the hypoglycaemic effect of antidiabetic agent. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia

Oral antidiabetics, trandolapril [2] ---> SmPC of [2] of eMC

Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.

Oral antidiabetics, trandolapril/verapamil [2] ---> SmPC of [2] of eMC

Increased reduction of blood glucose

Oral antidiabetics, tranylcypromine

Tranylcypromine may potentiate the effects of hypoglycaemic agents

Oral antidiabetics, travoprost/timolol [2] ---> SmPC of [2] of EMA

The beta-blocker may increase the hypoglycaemic effect of antidiabetic agent. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia

Oral antidiabetics, triamcinolone acetonide

Corticosteroids may increase blood glucose; diabetic control should be monitored, especially when corticosteroids are initiated, discontinued, or changed in dosage.

Oral antidiabetics, triamcinolone [2] ---> SmPC of [2] of eMC

Corticosteroids may increase blood glucose; diabetic control should be monitored, especially when corticosteroids are initiated, discontinued, or changed in dosage.

Oral antidiabetics, triamterene

Decrease of antidiabetic effect

Oral antidiabetics, trofosfamide

The co-administration may increase the blood-sugar reducing effect

Oral antidiabetics, trometamol

Trometamol enhances the hypoglycaemic effect of oral antidiabetics

Oral antidiabetics, zofenopril

Rarely ACE inhibitors can potentiate the blood glucose-reducing effects of insulin and oral antidiabetics like sulphonylurea, in diabetics.